Couples With Unexplained Infertility Can Benefit From Basic Treatments

Advances in fertility medicine continue to provide men and women with new, effective treatment options.

Dr. Caitlin Dunne
Specialist in fertility and egg freezing at the Pacific Centre for Reproductive Medicine based near Vancouver.

An article recently published in the Lancet medical journal shows promising results for couples struggling with unexplained infertility. The researchers demonstrated that even basic fertility treatment with intrauterine insemination (IUI) and fertility pills (clomiphene citrate or letrozole) could significantly improve pregnancy rates compared to waiting for things to happen naturally.

Infertility affects one in six couples. It's defined as failure to conceive after one year, and is often the result of sperm problems, irregular ovulation or blocked fallopian tubes.

As a fertility doctor, I perform basic tests on all couples struggling to conceive. These tests include: hormone panels to check the number of eggs remaining, hysterosalpingogram (HSG) to assess the fallopian tubes, ultrasound and sperm analysis.

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If all of these tests come back normal, the couple is diagnosed with unexplained infertility. The monthly pregnancy rate in these cases is a meagre one to four per cent.

Unexplained infertility makes up about 10 to 20 per cent of the patients I meet. Although it's reassuring to some couples that nothing is "wrong" with them, unexplained infertility can be a frustrating diagnosis. Couples often ask, "If we can't figure out what's wrong, then how can we treat it?"

Studies in the past that used IUI alone showed no benefit when compared to no treatment at all. In that protocol, women would track their ovulation at home and when the predictor kit turned positive, they headed to the fertility clinic for IUI.

Sperm is processed for IUI using a centrifuge density gradient that eliminates all of the debris and dead sperm, creating a concentrated sample of only the best swimmers. That sample is deposited directly into a woman's uterus via a catheter designed to fit through the cervix.

Advances in fertility medicine continue to provide men and women with new, effective treatment options.

Insemination can be of benefit to men with low sperm counts or poor sperm motility. For men with unexplained infertility, however, IUI alone is not enough to make a difference.

Fertility pills alone, such as clomiphene citrate or letrozole, have also been studied for unexplained infertility. Both medications are taken for five days per month in order to temporarily boost the level of follicle-stimulating hormone (FSH) and produce an extra egg or two. Unfortunately, the combination of these pills with intercourse is also ineffective.

In the latest study, more than 200 couples were randomly assigned to either expectant management or treatment with fertility pills and IUI. Over the next three months, the treatment group had a significantly higher live birth rate, 31 per cent, versus the expectant management group, nine per cent. The researchers concluded that, when used in conjunction with fertility medications, IUI is a "safe and effective treatment for women with unexplained infertility."

Advances in fertility medicine continue to provide men and women with new, effective treatment options. Sophisticated technologies like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are very effective, but they're also expensive and not covered by most provincial health insurance plans.

The newest research on fertility pills and IUI suggests that, for many couples, three months of this entry-level treatment may be sufficient to achieve their pregnancy goals.

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